title: Proximal direct endarterectomy combined with simultaneous distal endovascular therapy for chronic full-length occlusion of the superficial femoral artery in elderly patients.
abstract: OBJECTIVE
  The most proximal ostial site of the chronic occlusive superficial femoral artery is not suitable for ballooning or stenting because the deep femoral artery may be occluded by these procedures. Thus, the feasibility of performing an open endarterectomy for the occluded ostium of the superficial femoral arteries combined with an endovascular therapy for the remaining distal site was evaluated.
  
  
  METHODS
  Eleven critically ischemic limbs in 10 elderly patients with poor general health were enrolled. They had full-length occlusion of the superficial femoral artery involving its ostium. The ostial site was managed with an open endarterectomy followed by endovascular therapy for the remaining distal site.
  
  
  RESULTS
  All procedures were successfully performed. All patients experienced pain relief, and the wounds healed. During the follow-up observation period (average: 23.9 ± 14.7 months), nine patients died. None of the patients, including those who had lost patency of the superficial femoral artery, received major amputation.
  
  
  CONCLUSIONS
  Elderly patients, including those who were in terminal stage, were able to withstand the operation, and their postoperative quality of life was not compromised. Although the patency following the surgery was limited, sparing the deep femoral artery could either prevent or delay the recurrence of critical limb ischemia.
authors.affiliation: Department of Vascular Surgery, Kanoiwa Hospital, Kamikanogawa, Yamanashi City, Japan. mitsu88@mx5.nns.ne.jp
authors.forename: Mitsuyuki
authors.initials: M
authors.lastname: Nakayama
authors.forename: Fumikazu
authors.initials: F
authors.lastname: Sakamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004691:Endarterectomy / Q000379:methods*; D005240:Feasibility Studies; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D058729:Peripheral Arterial Disease / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome